Diagnosis of Acute Ischemic Stroke by CT scan and Diffusion Weighted MRI

Background: Acute ischemic stroke is the leading cause of death and disability. Anaccurate and practical understanding of imaging modalities is essential for themanagement of the acute stroke patients. Due to its widespread availability and speed,unenhanced Computed Tomography (CT) scan remains the initial study of choice forevaluating an acute stroke patients and Diffusion Weighted Magnetic ResonanceImaging (DWMRI) can detect abnormalities due to ischemia within 3 to 30 minutes ofonset, when conventional MRI and CT images would still appear normal.Objective:To compare the diagnostic role of CT scan and DWMRI in acute ischemic stroke andestablish the agreement between them.Methods: This cross-sectional study wasperformed on 110 patients from the Department of Radiology and Imaging, BSMMedical University Hospital, Dhaka, Bangladesh from July 2023 to August 2024.Patients were immediately transferred to the Department of Radiology and Imagingwhere they underwent comprehensive CT scans. Suspicion of acute ischemic strokewas present.Results: Total 110 patients were enrolled in this study. Almost one third(32.7%) patients belonged to age ≥70 years. The mean age was 61.11±12.49 years withrange from 32 to 90 years. Almost two third patients were male (60%) followed by(40%) female. More than (38.2%) patients were retired from job, followed by housewife (34.5%). It was observed that 20 (20%) patients experienced headache, (32.7%)vertigo, (49.1%) vomiting, (70.9%) hemiparesis/hemiplegia, Majority (81.8%) hadspeech disturbance. The location of infarct showed that (23.6%) patients were in M1segment (anterior circulation ASPECTS) followed by 52 (47.3%) in lentiform nucleusand 52 (47.3%) in internal capsule. Mass Effect were observed in both CT andDWMRI in 14 (12.7%) cases. More than (76.4%) patients showed parenchymalhypoattenuation (CT) and diffusion restriction (MRI) [CT, 76.4% and DWMRI,78.2%]. Regarding ADC value, it was observed that majority (74.5%) patients werebelow 0.6X10-3 mm2/s. The agreement analysis of the two modalities (parenchymalhypoattenuation (CT) with diffusion restriction (MRI)) was found showing a Kappavalue of 0.858 and p value <0.01. Conclusion: DWI-MRI is a better imaging methodin detecting early ischemic lesions in acute ischemic stroke patients.